fentanyl

(fen' ta nil)
Actiq; Duragesic 25, 50, 75, 100; Sublimaze Pregnancy Category C Controlled Substance C-II
Drug class

Opioid agonist analgesic
Therapeutic actions

Acts at specific opioid receptors, causing analgesia, respiratory depression, physical depression, euphoria.
Indications

• • • • • •

Analgesic action of short duration during anesthesia and immediate postoperative period Analgesic supplement in general or regional anesthesia Administration with a neuroleptic as an anesthetic premedication, for induction of anesthesia, and as an adjunct in maintenance of general and regional anesthesia For use as an anesthetic agent with oxygen in selected high-risk patients Transdermal system: Management of chronic pain in patients requiring opioid analgesia Actiq: Treatment of breakthrough pain in cancer patients being treated with and tolerant to opioids Contraindicated with hypersensitivity to opioids, diarrhea caused by poisoning, acute bronchial asthma, upper airway obstruction, pregnancy. Use cautiously with bradycardia, history of seizures, lactation, renal dysfunction.

Contraindications and cautions

• •

Available forms

Lozenge on a stick (Actiq)—200, 400, 600, 800, 1,200, 1,600 mcg; transdermal—25, 50, 75, 100 mcg/hr; injection—0.05 mg/mL
Dosages

Individualize dosage; monitor vital signs.
ADULTS

• • • •

Premedication: 0.05–0.1 mg IM 30–60 min prior to surgery. Adjunct to general anesthesia: Total dosage is 0.002–0.02 mg/kg. Maintenance dose, 0.025–0.1 mg IV or IM when changes in vital signs indicate surgical stress or lightening of analgesia. With oxygen for anesthesia: Total high dose is 0.05–0.1 mg/kg IV; up to 0.15 mg/kg may be necessary. Adjunct to regional anesthesia: 0.05–0.1 mg IM or slowly IV over 1–2 min.

lethargy. an additional dose can be used to treat an episode of breakthrough pain. mood changes. No more than two lozenges should be used for each breakthrough pain episode.05–0. Redosing may start 15 min after the previous lozenge has been completed. confusion. impaired mental and physical performance. Actiq should be sucked slowly over 15 min. headache. unusual dreams. euphoria. disorientation. Transdermal Initiate therapy with 25 mcg/hr system. sweating. repeat in 1–2 hr if needed. tremor. vertigo. hallucinations. Lozenges Place Actiq unit in mouth between cheek and lower gum. thiopental. Until appropriate dose is reached. light-headedness. Pharmacokinetics Route IV IM Transdermal Transmucosa l Onset 1–2 min 7–8 min Gradual 15 min Duration 0.5–1 hr 1–2 hr 72 hr 1 hr Metabolism: Plasma. nervousness. headache. Incompatibilities: Do not mix with methohexital. Protect vials from light. pentobarbital. delirium. Start with initial dose of 200 mcg. insomnia. Adverse effects • CNS: Sedation. Transdermal Do not exceed 15 mcg/kg. floating feeling.1 mg IM for the control of pain. clamminess. coma. or into running IV tubing. may enter breast milk IV facts Preparation: May be used undiluted or diluted with 250 mL of D5W. agitation. T1/2: 1. increase the dosage of long-acting opioid. may require replacement in 72 hr if pain has not subsided. Infusion: Administer slowly by direct injection.5–6 hr Distribution: Crosses placenta. tachypnea. Apply to nonirritated and nonirradiated skin on a flat surface of the upper torso. PEDIATRIC PATIENTS 2–12 YR Parenteral 2–3 mcg/kg IV as vital signs indicate. each mL over at least 1 min. dizziness. If more than four lozenges are needed daily. weakness. fear. seizures . anxiety. or emergence delirium. Lozenges 5–15 mcg/kg transmucosal Oralets.• Postoperatively: 0. adjust dose as needed and tolerated. Can consider increasing dose if requiring more than one lozenge for treatment of several consecutive breakthrough pain episodes.

normal output.• • • • • • • • CV: Palpitation. increased intracranial pressure. liver and kidney function tests Interventions . determinations of these levels may be unreliable for 24 hr after administration of opioids Nursing considerations CLINICAL ALERT! Name confusion has occurred between fentanyl and sufentanil. auscultation. pupil size. lipase. hypertension. COPD. tachycardia. increase or decrease in BP. local skin irritation with transdermal system Interactions Drug-drug • Potentiation of effects when given with other CNS acting drugs or barbiturate anesthetics. adventitious sounds. shallow respiration. pruritus. avoid this combination Drug-lab test • Elevated biliary tract pressure may cause increases in plasma amylase. anoxia. itraconazole. and protease inhibitors • Do not administer an MAOI within 14 days of fentanyl (increased CNS effects) Drug-food • Decreased metabolism and risk of toxic effects if taken with grapefruit juice. physical dependence on an opioid analgesic. vision. sensitivity to cold EENT: Diplopia. decrease dose of fentanyl when coadministering • Potentiation of effects may occur when given with macrolide antibiotics. labor. flushing. urinary retention or hesitancy. arrhythmia. tissue irritation and induration (SC injection) Respiratory: Slow. suppression of cough reflex. oliguria. anorexia. acute MI. antidiuretic effect. reflexes. pregnancy. biliary tract spasm GU: Ureteral spasm. laryngospasm. vomiting. R. dry mouth. lactation. reduced libido or potency Local: Phlebitis following IV injection. ventricular failure. use extreme caution. renal or hepatic dysfunction Physical: Orientation. apnea. BP. hives. P. bowel sounds. coronary insufficiency. palpitations Dermatologic: Rash. spasm of vesical sphincters. ketoconazole. blurred vision GI: Nausea. constipation. warmth. bronchospasm Other: Physical tolerance and dependence. shock. bradycardia. Assessment • • History: Hypersensitivity to fentanyl or opioids. cardiac arrest. respiratory depression. circulatory depression. pain at injection site. bilateral grip strength. psychological dependence. affect. biliary tract surgery.

palpitations. sedation. constipation (a laxative may help). Apply immediately after removal from the sealed package. shortness of breath. drowsiness. impaired visual acuity (ask for assistance if you need to move). These side effects may occur: Dizziness. . eat frequent small meals). or difficulty breathing. alcohol. allow skin to dry completely before application. making sure the contact is complete. Must be worn continually for 72 hr. do not use soap. oils. Use caution with Actiq form to keep this drug out of the reach of children (it looks like a lollipop) and follow the distribution restrictions in place with this drug very carefully.• • • • Administer to women who are nursing a baby 4–6 hr before the next scheduled feeding to minimize the amount in milk. Prepare site for transdermal form by clipping (not shaving) hair at site. loss of appetite (lie quietly. nausea. lotions. vomiting. Teaching points • • • Adverse effects in Italic are most common. Report severe nausea. firmly press the transdermal system in place with the palm of the hand for 10–20 sec. Keep opioid antagonist and facilities for assisted or controlled respiration readily available during parenteral administration. Do not drink grapefruit juice while using this drug. those in Bold are life-threatening.

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